Healthcare Provider Details

I. General information

NPI: 1285459644
Provider Name (Legal Business Name): EMAD M KHELLA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2024
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 COMMERCE BLVD STE 100
SUCCASUNNA NJ
07876-1343
US

IV. Provider business mailing address

463 OLD POST RD APT 202
EDISON NJ
08817-4693
US

V. Phone/Fax

Practice location:
  • Phone: 973-587-6404
  • Fax:
Mailing address:
  • Phone: 551-221-4933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ15216300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: